Saturday, November 17, 2007

In regard to SA "News Bulletin Number 11" (http://www.suspendedinc.com/news_archives11.html):Ms. Baldwin states that some of the information was "compiled by SA staff," but I think she probably meant SA consultants. I see Charles Platt's and Aschwin de Wolf's influence there, quite clearly, but I doubt much of “News Bulletin 11” was drafted by any of the SA staff members, other than Ms. Baldwin, herself.We all understand the “Vehicle Relocates to California” paragraph. The statement, “a significant number of our clients live in the West” is rather deceptive. What makes up “the West”? According to the US Census Bureau, “the West” is comprised of thirteen states, including Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming, but a broader definition may include all states west of the Mississippi River. (From http://en.wikipedia.org/wiki/Western_United_States )

How many SA clients will ever actually benefit from this vehicle, (or the other vehicle located in Southeast Florida)? The vehicle is really only practical for clients within a very small range. My guess is the vehicle will be retired after being used by one unofficial SA “client.” I wouldn’t really have an issue with Saul having his own cryomobile, if SA would quit trying to deceive their clients, and prospective clients, into believing the vehicle is going to be of use to a significant number of people. If you want a ride in one of the SA vehicles after your legal death, you had best relocate your home to someplace close to Kent or Faloon. Otherwise, you will most likely get a ride in a van rented at the airport closest to your home.

The “Perfusion Training” paragraph is arrogantly absurd. Why would you send three people, with no medical background, whatsoever, for a weekend training session and then expect them to be able to perform a medical procedure that can be tremendously beneficial when properly performed, but equally as dangerous when attempted by amateurs? It would be much more sensible to retain several qualified retired, or per diem, perfusionists to share call. This practice of training RUPs just does not make sense at SA, especially in light of their budget which is ample enough to pay for qualified personnel. I understand other organizations "doing the best they can," within a limited budget, but SA could afford the real thing. Becoming a perfusion technologist typically requires a four-year education that usually includes at least 100 supervised cases on actual human patients. It’s ridiculous to think a weekend training course and some video refresher courses are adequate training for this procedure. SA has only had ONE case in the last three years, how do they expect these amateurs to become proficient in perfusion technology without any real clinical experience? If this was rational, perfusion technology wouldn't require a BS degree.

The “AutoPulse” segment is interesting, especially the part that reads, “While the Thumper is still preferred for active chest compression and decompression…” Why is the Thumper “still preferred”? Because it offers active decompression, an advantage over the AutoPulse. This is an issue Aschwin de Wolf raised when Charles first suggested the very expensive AutoPulse project. Charles didn’t address Aschwin’s concerns with the AutoPulse anymore than he addressed Mathew’s concerns with the ramps, or my concerns with the level detectors, before embarking on yet another fruitless, expensive, time-consuming project.

In layman’s terms…the longer you keep squishing the chest down, the more likely it is to STAY squished down, making chest compressions ineffective. Rib fracture is the most common complication of chest compressions, and can lead to “flail chest,” something Aschwin addressed with Charles and others at SA, many times, in regard to the AutoPulse, a device that only compresses (squeezes) the chest, in comparison to the Thumper, a device that compresses AND decompresses (it suctions onto the chest wall and pulls up on the chest wall, opening the lungs and vasculature).

After a couple of years of working on the AutoPulse, SA (most likely Platt) now describes it as a “backup device.” SA already had a “backup device,” something they used as their PRIMARY device for the CI-81 case…manual chest compressions, something that is quite a bit more affordable and portable than the AutoPulse. Platt somehow convinced Kent to spend a ton of money on this project, (that no doubt has provided Platt with an ample amount of highly-paid “consulting” hours), without even considering the issues Aschwin raised, BEFORE the project was started. This is reminiscent of Platt's decision to choose homemade ramps over professionally installed lift gates, against Mathew Sullivan’s advice, and his determination to build his own level sensors/alarms, no matter how much time and money it meant to SA, in spite of the fact FDA-approved devices could be purchased for less than $400.

SA has purchased at least two AutoPulse devices at a price of $15,000 each, and has paid two people to work on this project for nearly two years, now. The combined cost of these two persons per hour, to SA, is greater than $100 per hour. In addition, these two people took their modified AutoPulse to CCR, in California, and let Harris and company test it on an animal. I suspect SA has spent at least $100K on this project, perhaps even double or triple that amount. Now it’s a “backup system”? Is SA going to carry TWO mechanical CPS devices with them? They are already carrying far too much equipment for remote cases. Common sense dictates that manual chest compressions should be the backup system for the Thumper. Common sense also dictates Platt should have addressed the lack of decompression issue when Aschwin raised it, before spending all that time and money.

As for the “Scribe Sheets,” Aschwin and I had begun working on these, not long before I left SA, against objections from Charles, who for whatever reasons, didn’t seem to like Aschwin and I working together, on anything.

As I’ve recently stated on the Cold Filter forum, there is no need for a person to operate solely as the scribe. While the surgeon and the paramedic cannot document while they perform their procedures, there should be two other persons available, including a perfusionist and a general case assistant. These two people should easily be able to document everything during the initial CPS and surgical portions of the procedure. In heart surgery, the perfusionist documents everything to do with the perfusion, including flows, temperatures, pressures, and much more, every ten minutes. Before and after the patient is “on pump,” the perfusionist is free to document other things. It only takes minutes for an experienced perfusionist to set up and prime the washout circuit.

The only thing I’m going to say about the “Patient Monitoring Training” and “End Tidal CO2” segments is: it’s idiotic to be training metal fabricators and golf pros to learn medical procedures paramedics, EMTs, perfusionists, and other medical personnel have already been thoroughly trained to perform, especially when you are paying the metal fabricators and golf pros up to more than triple what paramedics and EMTs earn, and as much as some perfusionists earn. Ms. Baldwin…show us your management skills…PLEASE…bring some sanity to all this.The “New Deployment Simulations” section causes me to have very mixed feelings. While, on the one hand, I am happy to see SA doing something more at training sessions than having Platt explain the damaging effects of ice, everyone practice on the Thumper, and then eat pizza, I am angry that Aschwin and I were not able to achieve this, in spite of our efforts, a year ago, thanks to heavy interference from Platt.

Before he resigned, Charles put Aschwin and me “in charge” of one training session. We had planned to have the patient (a medical mannequin) expire upstairs, in my home, a short distance from the SA facility, and transport the patient back to the facility. We wanted to have only a small number of attendees, instead of the large number Platt was accustomed to inviting. Unfortunately, after he put us “in charge,” Charles proceeded to invite quite a number of people. Having 20 people ride in the SA van and enter my home wasn’t really desirable, nor was it a realistic case simulation, so Aschwin and I abandoned that scenario.

After Charles allegedly resigned, the SA staff planned another training session. We planned on inviting only six people whom we considered to be candidates to replace Charles as Saul’s designated “Team Leader.” Surprise, surprise…our “consultant,” Charles Platt contacted a number of the SA standby team members, (some in other states), to notify them of the upcoming training session. I actually had to call people and uninvite them. Hopefully, I was tactful in explaining we no longer wanted to have the large unproductive social gatherings, but were intending to have frequent, more focused sessions, for smaller groups. It's unrealistic to bring 20 people in a few times a year, give them a brief overview of the entire process, do a quick run-through of a simulated case, and expect anyone to remember what to do in the event of an actual case.

Why did Aschwin and I have to resign, before anyone would take our advice, at SA? I gave up a $75K salary, and spent the last six months posting on Cold Filter and my blog, and Aschwin resigned to work with Alcor, and NOW SA is doing what Aschwin and I suggested a long time ago? I guess Aschwin is the smarter of the two of us...at least he's still getting paid as a consultant, while I'm giving SA free advice through my criticisms of them. That's really horrible...they had my expert advice, but I had to leave and become their harshest critic before they would listen to any of it? In my opinion, this was due to Platt's greed and his egotistical need to believe no one can do anything better than he can, and Kent's failure to realize Platt was not really accomplishing anything of significance.

After Charles resigned, I discussed with the other staff members, the idea of having smaller groups do focused training. For instance, I wanted to select a few people to train as designated “perfusionists,” and train them thoroughly, with frequent refresher courses. We had two research scientists who could have worked together on training a few people in the surgical (cannulation) skills. We had a group of paramedics who needed new contracts, but probably would have been a little more devoted if they had ever been respected by Platt and his RUPs.

The paramedics had little devotion to SA, for good reason, in my opinion. When they came to Platt’s training sessions, they received the same information and instruction time-after-time. They saw things that could be improved and made suggestions, only to have their suggestions ignored. In the SA staff debriefings that were held after the training sessions, the paramedics were harshly criticized by Platt and his RUPs, who seemed to think their own knowledge base in regard to the medical procedures was somehow superior to that of the paramedics. Again…stabilization and transport are nothing new…paramedics and EMT’s have been successfully performing these procedures for decades. The only things that might be new to them would be the packing of the patient with ice and the use of the Thumper, (tasks that don’t exactly require a rocket scientist). It didn’t matter that the medications were different, they are still administered the same way, through an IV line.

The paramedics were critical of the PIB, the ramps, and some of the other equipment, just as I was, for good reason. The “transportable” PIB was heavy, cumbersome, and a pain to set up. At the last training session I attended, an SA staff member took 15-20 minutes to set up the PIB, while reading the instructions, and he had practice! As the paramedics stated, this device should be lighter, and setup should be obvious, something that should be able to be accomplished in less than a minute, without instructions.

The SA ramps are not only moronic, in comparison to lift gates, they are dangerous. When you factor in the man-hours of Platt and his fabricators, the ramp systems were significantly more expensive than lift gates. Everyone knows they are foolish devices. Even Charles’ right hand fabrication man said to me, “You and I both know the ramp was a stupid waste of time and money, let’s just wait until he leaves and we’ll get a lift gate.” At which point I said he was delusional if he thought Charles was going to jump off the SA gravy train, anytime soon.

It’s time for Ms. Baldwin to show us what she is made of. Is she a manager, or a mouse? Ms. Baldwin knows the salaries and consulting fees being paid by SA are inappropriate; she could have qualified personnel for the same price, (actually, for much less). She also knows the selection of personnel and consultants is inappropriate. The SA personnel are extremely underqualified to perform medical procedures, yet some of them are being paid more than three times as much as paramedics, and ridiculously more than what they should be paid for the tasks they perform, (building Platt's designs, basic bookkeeping, text-messaging their friends, etc.) Finally, if Ms. Baldwin approves of the equipment SA is using, it could only be because she is unaware of existing, more professionally constructed, less expensive alternatives. When are the REAL changes coming, at SA, Ms. Baldwin, or are your hands tied? Are you the REAL manager of SA? Do you actually have the power to change things, or are we going to keep getting more of the same foolishness in regard to unqualified personnel, lack of progress and total fiscal irresponsibility?

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